Surgical robot gives NHRMC patients better results

Friday

Nov 16, 2012 at 12:45 PM

The robot also offers the advantage of less blood loss than with laparoscopic surgery

By Jim WareJim.Ware@StarNewsOnline.com

Note: This story has been updated. A previous version included an incomplete explanation of how the robot results in less pain for the patient.Dewanda Hines had robotic-assisted surgery Sept. 19 at New Hanover Regional Medical Center to remove fibroid tumors from her uterus and became a fan of the relatively new technology.Hines, 45, of Jacksonville said she stayed in the hospital an extra day because of blood pressure issues unrelated to surgery, but was discharged Sept. 21.Hines said recovery time with robotic surgery is faster than previous open and laparoscopic surgeries she's had."To me you don't be in a lot of pain," she said. "You've just got little holes. I would recommend to anybody to get it."Dr. Walter Gajewski, the gynecological oncologist who performed Hines' surgery, also recently performed the 1,000th robotic surgery at the hospital since the $1.5 million da Vinci Surgical System was introduced in October 2008."Robotic surgery basically is a tool to help us perform the surgeries that we would do ordinarily for patients with cancer or other conditions that require surgery," Gajewski said.Most people are familiar with laparoscopic surgery, sometimes called Band-Aid surgery because of the tiny incision the surgeon makes to access the abdomen. The surgeon inserts a camera and tools through the incision rather than making the larger incisions commonly associated with open surgery."Anyone that's able to have minimally invasive surgery benefits because they don't have a large incision to recover from, therefore there's less pain, they're not in the hospital as long after their surgery because of that and their recovery time therefore at home is quicker," Gajewski said.He said the da Vinci Surgical System robot used at NHRMC has "allows us to use instruments that can articulate and move, and follow the direction of your hands the way you would normally operate just using regular tools in your hands." Instruments used in standard laparoscopy are basically straight sticks that are limited in their abilities to move around inside the patient, he said.Catherine Mohr, medical research director for Intuitive Surgical, manufacturer of the da Vinci Surgical System, said the console the surgeon sits at during surgery has controls that allow one-to-one motion."You make a motion with your hand and you get this duplicated motion inside of the patient," Mohr said.A neutral point on the instrument, placed at the abdominal wall, remains stationary so that the incision is not battered during surgery, resulting in less pain for the patient, Mohr said.The fact that the surgeon sits comfortably at a console rather than standing over the patient during surgery also reduces skeletal strain, allowing some surgeons to extend their careers, she said.Another advantage of the robot is that it offers 3-D, binocular vision with depth perception that's magnified instead of the 2-D vision available with laparoscopy, Gajewski said."What that does is allow us to see things better and recognize tissues like nerves that can be spared injury that otherwise wouldn't be seen with the naked eye, to cauterize vessels that would otherwise bleed or ooze during surgery," Gajewski said.The robot also offers the advantage of less blood loss than with laparoscopic surgery because the surgeon is cauterizing, or burning, tissues rather than cutting and sewing, he said.."I think that there are cases that would be very difficult to do laparoscopically that we can do more easily robotically because of the vision that we have and the ability to move and manipulate tissues in a way that allows us more flexibility," Gajewski said.Gajewski said surgeons at NHRMC use the robot to assist in urology, gynecology and oncology cases, as well as general surgeries.Although surgeons using the robot are initially more deliberate and cautious, they become faster with experience, said Gajewski, who has done 250 to 300 robotic surgeries so far."I can honestly say that I can do a robotic hysterectomy faster than I can do a laparoscopic hysterectomy," he said.Surgery can be a little more expensive with the robot than with laparoscopic surgery, he said, mostly because the hospital receives less reimbursement when it is used.But the volume of robotic surgeries performed at the hospital has reached the point where another robot is needed he said. The hospital is projected to be performing 300 to 400 robotic surgeries a year, and that's what experts say is the maximum volume for one machine, he said.One reason for the increase demand is more use of robotic surgery to treat some cancers."More than 80 percent of endometrial cancers, one of the most common cancers, are treated roboticially," Gajewski said. "Five years ago, all were done open or laparoscopically. It has really been the biggest change I think that we've seen in GYN oncology in the last 10 years."He said the technoclogy has aided surgeons with what they need to do for patients."It's not changing what we do for the patients, it's just improving the way we do it," he said. "It helps us and it helps the patients. To see someone go through being in the hospital five or seven days after surgery and seeing them going home the next day is like night and day."

Jim Ware: 343-2387On Twitter: @jimware

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